Paediatric triage practice and emergency severity index in the Maltese Islands

Abstract

BACKGROUND: In the paediatric emergency department (PED) triage is a keystone service designed specifically for the recognition of severely ill patients. In this study, the local paediatric triage practice was assessed.

METHODS: Data was collected retrospectively for children under 16 years of age presenting to the PED during the first seven days of August 2018, September 2018, January 2019 and February 2019. A triage priority category was assigned according to the Emergency Severity Index (ESI) algorithm (version 4) and compared to that assigned by the triage nurse.

RESULTS: The kappa coefficient for inter-rater reliability (triage nurse vs investigator) was 0.360 (95% CI 0.329, 0.390). Weighted kappa was calculated to be 0.424 (95% CI 0.395, 0.454). Concordance between nurse triage and investigator triage was present for 51.32% of cases, whilst Chi-squared test showed significant differences between raters for the categories ESI-2, ESI-3, and ESI-5.

CONCLUSION: This study has highlighted some concerns with our local paediatric triage practices, with fair to moderate agreement for inter-rater reliability, and the possibility of significant over-triage. The main recommendation is that paediatric triage is carried out by healthcare professionals who are experienced in dealing with sick children.